Introduction

Lately, we have witnessed a re-emergence of old diseases and the emergence of new diseases. In the process of globalization of the world today, spreading the disease from one location to another location in the world or in one’s country is extremely difficult to curb. This, in turn, affects the socio-economic and sometimes giving a negative effect on any population or a state. How does it exist or recurred is sometimes difficult to understand. This resulted in the detection and control activities becomes less effective and efficient. Diseases such as SARS (Severe Acute Respiratory Syndrome), Pandemic Influenza, H1H1, H5N1, Ebola and Mers-Cov (Middle East Respiratory Coronavirus) are among the diseases emerging in the human ecosystem and sometimes in human and animal ecosystems. At the same time, diseases such as cholera, food poisoning, dengue, and TB remain major public health challenges. People lifestyle also increases the risk of non-communicable diseases such as diabetes, hypertension, cardiovascular disease and other health problems like obesity and stress.

To face the challenges, responsibilities, the role of prevention and control and health care needs thorough comprehensive changes to make it more effective, efficient and focusing on real problems or issues that need to be addressed collectively and comprehensively. We can no longer depend solely on public health services provided by the government.

To address the issues, the World Health Organization (WHO) has introduced an approach called COMBI (Communication For Behavioural Impact) that aims to mobilize individuals, families, communities or any other target group to identify risk factors, change or adopt a behavior that is required on an ongoing basis in preventing or controlling disease that affects their health and the community. Communication strategy and mobilization in existing community organizations will be used and improved and the community will also be given guidance by the Ministry of Health.

Many countries in the world have adopted this program in accordance with the needs, desire and health problems they face in their country. For example, in Sudan (2004) for controlling the Ebola outbreak, in Fiji (2006) for controlling Measles outbreaks and Cambodia (2004) for controlling the Influenza epidemic. In Malaysia, disease control program using the COMBI approach especially in dengue control initiatives have been initiated with the community beginning in 2001.

In Malaysia, dengue is among the infectious diseases that still represents public health problems. Various activities were undertaken by the Ministry of Health to prevent and control diseases such as dengue fever by destroying Aedes breeding sites, thermal space spraying using insecticides, larviciding and enforcement of the Destruction of Disease-Bearing Insects Act 1975 (Amendment 2000).

Organization Of COMBI

Normally, representatives from Ministry of Health will hold a meeting with community organizations to inform and discuss their health problems or issues. Community organizations will further initiate other members of the community through formed committee among the community members together with other government agencies or the private sectors related to the activity to be undertaken. The organization will implement 5 COMBI’s strategies together with the agencies involved, namely:

1. Advocating public relations and administration
   • Establish a special committee or using existing community committees to handle COMBI in their locality.
   • COMBI membership is established through the Regional Dengue Action Plan Workshop.
   • COMBI membership is placed under the responsibility of the Regional Dengue Action Committee.
   • COMBI Programme is placed or adopted by local authorities through LA21 Programme.
   • Activate all services provider personnel to hold meeting or discussions with various agencies, giving lectures, explanations, briefings and inform the community about practicing desired healthy behavior change.
2. Social mobilization
   • Connecting organization with other community members and involving them in activities related to COMBI.
   • Conducting talk by guest lecturers.
   • Through “Special Mobilization Program”.
   • This action focuses on community involvement in delivering the desired behavior messages.
   • The act of communication, including the use of participatory research, community meetings, road shows, home visits and so on.
3. Advertising
   • Deliver desired health behaviors message to community through printed and electronic media (posters, leaflets, public address, “wayang pacak” and dengue pit stop).
   • The behavior messages is channelled to draw public attention to the proposed behaviour changes.
4. Personal Delivery / Interpersonal Communication
   • Appoint a sub-locality promoter or a facilitator to work and explain in more detail and clarity.
   • Use massive method, repetitive, focused and continuous.
5. Promotion of service centers in the localities
   • >Identify strategic locations in the locality for the purpose of conducting a service center for COMBI activities such as advisory services, provision of collateral and exhibition (hall, operation room and office volunteers).

COMBI Objectives

• Empowering communities to change the present behavior to a new behavior that is introduced.
• Reduce the incidence of infectious diseases, especially dengue in the district and the state.
• Encourage and enhance inter-agency collaboration to prevent and control the incidence of infectious diseases, particularly dengue fever.

Community Responsibility

In our country, the COMBI program implemented by the Ministry of Health focused on the prevention and control of dengue fever. However, now the COMBI program now has been extended to issues and other health problems such as COMBI KCHS (Healthy Lifestyle Campaign) in the form of the promotion of healthy behaviors such as walking 10,000 steps, healthy eating and other fitness activities. Research shows any community that perform COMBI with commitment and persistent, may resolve or significantly reduce the negative health effects of health issues they face, such as the reduction of dengue cases.

In implementing the COMBI program, the community has to ensure 3 important aspects to be addressed so that the goal of these changes can be sustained and continued, namely;

Knowledge

• About dengue fever as well as methods to control and prevent the spread.
• The life cycle of the mosquito and how to control and prevent mosquito breeding.
• Law enforcement in the control and prevention of dengue fever.

Attitude

• Towards breeding places of mosquitoes.
• Towards cleaning water storage containers.
• About the use of insecticides/larvicides.
• Abaout the importance of thermal fogging activities inside or outside the home.
• Towards selfcare and be concerned about the cleanliness of their environment and even neighbors.

Practices

• Making inspection once a week, inside or outside the house, looking for containers that may become breeding ground for mosquitoes and eliminating the sources.
• Regularly check and clean any water containers.
• Always be positive and ready to share information and practices with other community members.

To start a COMBI programme, the most important thing that the community required is awareness towards the health problems and the preventive measures to avoid health issues that occur among them. Therefore, a real community responsibility is to drive all the other members of the community so that the desired behavior is achieved and maintained. In addition, the community is also responsible for creating a partnership that could make the society become the behavioural change agent in terms of disease prevention. This is consistent with the concept of community to the community and the Ministry of Health will always be ready to help and assist any members of the public who would like to run the program with the COMBI Community in their place.

References:

1. Communication for Behavioural Impact (COMBI): a toolkit for behavioral and social communication in outbreak response World Health Organization; UNICEF; Food and Agriculture Organization of the United Nations (2012).
2. Guidelines on the Implementation of the Program of Communication for Behavioural Impact (COMBI) – Prevention and Control of Dengue  Vector Borne Disease Control Division, Department of Public Health, Ministry of Health Malaysia.
3. Destruction of Disease-Bearing Insects Act 1975 (Amendment 2000)